血清Clusterin、ADAMTS-13与老年急性心力衰竭患者病情及预后的关系  

The Relationship Between Serum Clusterin,ADAMTS-13 and the Condition and Prognosis of Elderly Patients with Acute Heart Failure

作　　者：黄柳[1] 崔坤 田小超[1] 邱翔[2] 郭炳彦[1] 李拥军 HUANG Liu;CUI Kun;TIAN Xiaochao;QIU Xiang;GUO Bingyan;LI Yongjun(The Fourth Departments of Cardiovascular Medicine,the Second Hospital of Hebei Medical University,Shijiazhuang 050004,China;Department of General Medicine,the Second Hospital of Hebei Medical University,Shijiazhuang 050004,China)

机构地区：[1]河北医科大学第二医院心血管内四科,河北石家庄050004 [2]河北医科大学第二医院全科医学科,河北石家庄050004

出　　处：《标记免疫分析与临床》2024年第1期76-80,113,共6页Labeled Immunoassays and Clinical Medicine

基　　金：2023年河北省医学科学研究课题(编号:20230057);2020年河北省自然科学基金面上项目(编号:H2020206504)。

摘　　要：目的 探讨簇集蛋白(Clusterin)、血管性血友病因子裂解蛋白酶(ADAMTS-13)在老年急性心力衰竭(AHF)患者血清中的表达以及与预后的关系。方法 选取2020年1月至2021年12月在我院接受治疗的80例老年AHF患者进行研究,根据病情的严重程度分为轻度AHF组(n=34)和重度AHF组(n=46),根据1年内是否发生终点事件分为无终点事件组(n=58)和终点事件组(n=22),另选取同期门诊健康体检者80例为对照组。采用多因素Logistic回归分析老年AHF预后的影响因素;受试者工作特征(ROC)曲线分析血清Clusterin、ADAMTS-13水平对老年AHF预后的预测价值。结果 AHF组血肌酐、肌酸激酶同工酶(CK-MB)、脑钠肽(BNP)、N末端脑钠肽前体(NT-proBNP)、肌钙蛋白I(cTnI)、左心室舒张末期内径(LVEDD)、Clusterin显著高于对照组(P<0.05);左心室射血分数(LVEF)、ADAMTS-13显著低于对照组(P<0.05)。重度AHF组Clusterin显著高于轻度AHF组(P<0.05);ADAMTS-13显著低于轻度AHF组(P<0.05)。与无终点事件组相比,终点事件组血肌酐、CK-MB、BNP、NT-proBNP、cTnI、LVEDD、Clusterin显著升高(P<0.05);LVEF、ADAMTS-13显著降低(P<0.05)。多因素Logistic回归分析结果显示,血清ADAMTS-13是老年AHF预后的保护因素(P<0.05);Clusterin是危险因素(P<0.05)。血清Clusterin、ADAMTS-13二者联合预测老年AHF患者预后的AUC为0.980,灵敏度为90.91%,特异性为96.55%,优于Clusterin、ADAMTS-13各自单独预测(Z二者联合-Clusterin=2.219、Z二者联合-ADAMTS-13=2.269,P=0.027、0.023)。结论 老年AHF患者血清Clusterin表达显著上调,ADAMTS-13表达显著下调,二者联合检测对老年AHF患者预后有较好预测价值。Objective To investigate the expression of Clusterin and von Willebrand factor cleaving protease(ADAMTS-13)in serum of elderly patients with acute heart failure(AHF)and to evaluate their relationships with prognosis.Methods Eighty elderly patients with AHF who were treated in our hospital from January,2020 to December,2021 were selected for study.According to the severity of the disease,these patients were grouped into the mild AHF group(n=34)and severe AHF group(n=46),while according to whether terminal events occurred within one year,these patients were divided into the non-terminal event group(n=58)and terminal event group(n=22).Another 80 outpatients with physical examination were regarded as the control group.Multivariate logistic regression was applied to analyze the factors affecting the prognosis of elderly AHF;The predictive value of serum Clusterin and ADAMTS-13 levels on the prognosis of elderly AHF was analyzed by the ROC curve.Results The levels of serum creatinine,creatine kinase isoenzyme(CK-MB),brain natriuretic peptide(BNP),N-terminal pro B type natriuretic peptide(NT-proBNP),troponin I(cTnI),left ventricular end-diastolic diameter(LVEDD)and Clusterin in AHF group were significantly higher than those in the control group(P<0.05);Left ventricular ejection fraction(LVEF)and ADAMTS-13 were significantly lower than those in the control group(P<0.05).Clusterin in severe AHF group was significantly higher than that in the mild AHF group(P<0.05);ADAMTS-13 was significantly lower than that in the mild AHF group(P<0.05).Compared with the non-terminal event group,serum creatinine,CK-MB,BNP,NT-proBNP,cTnI,LVEDD and Clusterin in the terminal event group were significantly higher(P<0.05);LVEF and ADAMTS-13 were significantly decreased(P<0.05).Multivariate logistic regression analysis showed that serum ADAMTS-13 was a protective factor for the prognosis of elderly AHF(P<0.05),while Clusterin was a risk factor(P<0.05).The AUC of the combination of serum Clusterin and ADAMTS-13 in predicting the prognosis of eld

关 键 词：簇集蛋白 血管性血友病因子裂解蛋白酶 老年急性心力衰竭 预后 

分 类 号：R541.6[医药卫生—心血管疾病]